Incidence of Suture-Method Catheter Dislocation with Femoral Nerve Block and Femoral Triangle Block after Total Knee Arthroplasty.

Catheter dislocation with continuous peripheral nerve blocks represents a major problem in clinical settings. There is a range of factors affecting the incidence of catheter dislocation, including catheter type. This study aimed to assess the incidence of suture-method catheter (SMC) dislocation 24 h after total knee arthroplasty (TKA), with continuous femoral nerve block (CFNB) and continuous femoral triangle block (CFTB), respectively. In the prospective randomized trial, 40 patients qualified for TKA with SMC and were divided into two groups, those who received CFNB (Group 1, n = 20) and those who received CFTB (Group 2, n = 20). After 24 h, the degree of catheter displacement (cm), pain intensity (NRS) and opioid consumption (mg) was assessed. The catheter dislocation rates were found to be 15% in Group 1 versus 5% in Group 2, with the catheter dislocated by 0.83 cm (SD = ±0.87) and 0.43 cm (SD = ±0.67), respectively. There were no differences in NRS score (p = 0.86) or opioid consumption (p = 0.16) between the groups. In each case, a displaced catheter was successfully repositioned by pulling, which clinically resulted in a lower NRS score. The results of the study suggest that CFTB with SMC may be used after TKA with a good effect, as it is associated with low catheter dislocation rates and an adequate analgesic effect.

Radiological and Clinical Efficacy of Intra-Arterial 90Y-DOTATATE in Patients with Unresectable, Progressive, Liver Dominant Neuroendocrine Neoplasms.

This study was performed to determine if intra-arterial (i.a.) administration of 90Y DOTATATE can provide an effective and safe alternative to the accepted standard for i.v. of peptide receptor radionuclide therapy (PRRT) in liver-dominant metastases of gastrointestinal pancreatic neuroendocrine neoplasm (GEP-NEN). A single site, prospective, preliminary case series study included 39 patients with histologically proven liver-dominant NEN. PRRT in the form of 1.15GBq 90Y DOTATATE was given selectively into the liver via radiological catheterization of the hepatic artery, up to four times. The endpoint was radiological response (RECIST). Secondary endpoints assessed clinical well-being post-treatment, progression-free survival (PFS), overall survival (OS), and toxicity. Partial response (PR) was noted in 13% of subjects six weeks post-therapy, increasing to 24% at six months and dropping to 13% at 36 months. Disease progression (DP) was not seen at six weeks, was 5% at six months, and 47% at 36 months. Clinical response based on PS seen in 74% of patients at six weeks, 69% at six months, and 39% at 36 months had PFS and OS, respectively, of 22.7 months and 38.2 months. There was no difference in OS/PFS between those with RECIST PR and SD. One patient had significant toxicity (3%). Use of i.a. PRRT appears to be safe and effective in treating patients with liver-dominant NEN. In addition, the best OS (51 vs. 22 months) was seen when i.a. was used as an upfront treatment of bulky GEP-NEN liver metastases and not after i.v. 90Y DOTATATE. The use of i.a. 90Y DOTATATE PRRT appears to be safe and effective in treating patients with liver-dominant NEN.

Levosimendan in the modern treatment of patients with acute heart failure of various aetiologies.

Acute decompensated heart failure (ADHF) is a common clinical problem associated with a high mortality rate. Because ADHF has various aetiologies, there are a range of therapeutic options, among others, positive inotropes (inotropic drugs). As an inotropic agent whose mechanism is different than that of "classical" medicines, levosimendan (LSM) is one of the most common therapeutic options. Despite many publications on LSM, some issues related to its application remain unclear. The authors of this paper have attempted to summarise expert recommendations and reports available in the literature.

Outcomes of Patients with Pulmonary Large Cell Neuroendocrine Carcinoma in I-IV Stage.

Background and Objectives: Large cell neuroendocrine cancer is characterised by poor prognosis. The standard of treatment is still not established. The aim of this study was to assess the predictive factors of overall survival (OS) and progression-free survival (PFS) of pulmonary large cell neuroendocrine carcinoma (LCNEC) and combined LCNEC. Materials and Methods: All patients had confirmed pathology stage I-IV disease recorded between period 2002-2018. Survival curves were estimated by Kaplan-Meier method. Uni- and multivariable analysis was conducted using Cox-regression analysis. Results: A total of 132 patients with LCNEC and combined LCNEC were included. Half of them had clinical stage IIIB/C-IV. Patients were treated with radical (n = 67, including surgery alone; resection with neo-adjuvant or adjuvant chemotherapy, radiochemotherapy, or adjuvant radiotherapy; patients treated with radiochemotherapy alone), palliative (n = 41) or symptomatic (n = 24) intention. Seventeen patients were treated with resection margin R1 or R2. Non-small cell carcinoma (NSCLC) chemotherapy (platinum-vinorelbine; PN schedule) and small-cell lung carcinoma (SCLC) chemotherapy approaches (platinum/carboplatinum-etoposide; PE/KE schedule) were administered in 20 and in 55 patients, respectively. The median (95% Confidence Interval (CI)) OS and PFS were 17 months (9.0-36.2 months) and 7 months (3.0-15.0 months), respectively. Patients treated with negative resection margin, with lower clinical stage, without lymph node metastasis, and with size of primary tumour ≤4 cm showed significantly better OS and PFS. The main risk factors with an adverse effect on survival were advanced CS and positive resection margin. Conclusions: Patients with LCNEC characterized poor prognosis. Independent prognostic factors influencing PFS were initial clinical stage and resection margin R0 vs. R1-2.

[Arterial embolisation for post-traumatic retroperitoneal bleeding]. / Embolizacja naczyn tetniczych jako metoda zaopatrzenia krwawien zaotrzewnowych u chorych niestabilnych hemodymicznie.

BACKGROUND: Road traffic accidents resulting in multiple organ trauma are among the leading causes of mortality among people under 45 years of age. Those with pelvic injury are at special risk, because of difficult haemostasis and massive bleeding of mixed origin. Various methods of treatment have been used, including laparotomy, direct clamping and ligation of affected vessels, retroperitoneal packing, and external/internal pelvic stabilisation. In selected cases, angioembolisation of various vessels can be used CASE REPORTS: A 24-year-old male patient was admitted after a road traffic accident, in which he suffered multiple injuries to the skull, abdomen and pelvis. An emergency laparotomy was performed, revealing ruptures of the spleen, mesentery, right ureter, and bladder, and a giant haematoma in the retroperitoneal space. The spleen was removed, and the traumatised organs temporarily repaired. The pelvis and femoral bones were stabilised externally. After surgery, the patient was transferred to the ITU; he was haemodynamically unstable due to coagulopathy and persistent bleeding from the superior gluteal artery. On the fourth day, angioembolisation of the latter was performed using three occluding coils that resulted in immediate control of the bleeding and haemodynamic stabilisation. DISCUSSION AND CONCLUSION: In selected cases of severe bleeding from a traumatic pelvic injury, angioembolisation can be used as a lifesaving technique, especially in patients with coagulopathy after ineffective surgical interventions.

[Sugammadex--two years in clinical practice]. / Dwa lata doswiadczen z zastosowaniem sugammadeksu w praktyce klinicznej.

Sugammadex is a modified gamma cyclodextrin, specifically designed for the reversal of neuromuscular blockade (NMB) induced by the steroidal neuromuscular blocking agents, rocuronium and vecuronium. Sugammadex acts by encapsulating the unbound drug molecules and reducing their concentration at the neuromuscular junction, allowing rapid reversal of NMB at every stage. Unlike acetylcholinesterase inhibitors, sugammadex is also effective in the reversal of profound NMB and is well tolerated. The recommended doses are in the range of 2-16 mg kg(-1), depending on the intensity of the block. Perioperative neuromuscular transmission monitoring is mandatory in enabling the choice of the right doses of sugammadex. This review presents various aspects of the use of sugammadex in adult and paediatric patients, and provides guidelines for practical administration.